Karnofsky performance status predicts outcomes in candidates for simultaneous liver‐kidney transplant

Shamseddeen, Hani; Pike, Francis; Ghabril, Marwan; Patidar, Kavish R.; Desai, Archita P.; Nephew, Lauren; Anderson, Mary R.; Kubal, Chandrashekhar A.; Chalasani, Naga; Orman, Eric S.

doi:10.1111/ctr.14190

Cited by 12 publications

(11 citation statements)

References 33 publications

(41 reference statements)

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“…Nine studies [93][94][95][96][97][98][99][100][101] and 16 studies [102][103][104][105][106][107][108][109][110][111][112][113][114][115][116][117] were conducted in heart and lung transplant candidates, respectively. Four studies [118][119][120][121] included double organ transplant candidates (i.e., kidney and liver transplant candidates or heart). No studies that met our inclusion criteria have been published in pancreas transplant candidates.…”

Section: Study Characteristicsmentioning

confidence: 99%

Frailty and solid-organ transplant candidates: a scoping review

et al. 2022

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Background There is currently no consensus as to a standardized tool for frailty measurement in any patient population. In the solid-organ transplantation population, routinely identifying and quantifying frailty in potential transplant candidates would support patients and the multidisciplinary team to make well-informed, individualized, management decisions. The aim of this scoping review was to synthesise the literature regarding frailty measurement in solid-organ transplant (SOT) candidates. Methods A search of four databases (Cochrane, Pubmed, EMBASE and CINAHL) yielded 3124 studies. 101 studies (including heart, kidney, liver, and lung transplant candidate populations) met the inclusion criteria. Results We found that studies used a wide range of frailty tools (N = 22), including four ‘established’ frailty tools. The most commonly used tools were the Fried Frailty Phenotype and the Liver Frailty Index. Frailty prevalence estimates for this middle-aged, predominantly male, population varied between 2.7% and 100%. In the SOT candidate population, frailty was found to be associated with a range of adverse outcomes, with most evidence for increased mortality (including post-transplant and wait-list mortality), post-operative complications and prolonged hospitalisation. There is currently insufficient data to compare the predictive validity of frailty tools in the SOT population. Conclusion Overall, there is great variability in the approach to frailty measurement in this population. Preferably, a validated frailty measurement tool would be incorporated into SOT eligibility assessments internationally with a view to facilitating comparisons between patient sub-groups and national and international transplant services with the ultimate goal of improved patient care.

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Section: Study Characteristicsmentioning

confidence: 99%

Frailty and solid-organ transplant candidates: a scoping review

et al. 2022

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“…[24,25] Frailty is also associated with increased post-SLKT mortality, liver and kidney graft losses, and hospital length of stay at index admission. [26] As such, methods to boost pre-SLKT nutritional status, including using tube feeds and prehabilitation measures, may have important impacts for improving post-SLKT early hospitalization risk.…”

Section: Discussionmentioning

confidence: 99%

“…MELD-Na were 27.2 kg/m 2 (IQR, 23.6-32.2 kg/ m 2 ) and 28 (IQR,[23][24][25][26][27][28][29][30][31][32][33][34], respectively. Hypertension and diabetes mellitus were prevalent in 54% and 42%, respectively.…”

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confidence: 99%

Burden of early hospitalization after simultaneous liver–kidney transplantation: Results from the US Multicenter SLKT Consortium

Sharma¹,

Xie²,

Wang³

et al. 2022

Liver Transpl

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The burden of early hospitalization (within 6 months) following simultaneous liver-kidney transplant (SLKT) is not known. We examined risk factors associated with early hospitalization after SLKT and their impact on patient mortality conditional on 6-month survival. We used data from the US Multicenter SLKT Consortium cohort study of all adult SLKT recipients between 2002 and 2017 who were discharged alive following SLKT. We used Poisson regression to model rates of early hospitalizations after SLKT. Cox regression was used to identify risk factors associated with mortality conditional on survival at 6 months after SLKT. Median age (N = 549) was 57.7 years (interquartile range [IQR], 50.6-63.9) with 63% males and 76% Whites; 33% had hepatitis C virus, 20% had non-alcohol-associated fatty liver disease, 23% alcoholassociated liver disease, and 24% other etiologies. Median body mass index (BMI) and Model for End-Stage Liver Disease-sodium scores were 27.2 kg/ m 2 (IQR, 23.6-32.2 kg/m 2 ) and 28 (IQR, 23-34), respectively. Two-thirds of the cohort had at least one hospitalization within the first 6 months of SLKT.Age, race, hospitalization at SLKT, diabetes mellitus, BMI, and discharge to subacute rehabilitation (SAR) facility after SLKT were independently associated with a high incidence rate ratio of early hospitalization. Number of hospitalizations within the first 6 months did not affect conditional survival. Early hospitalizations after SLKT were very common but did not affect conditional

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“…Additionally, studies have shown that in patients awaiting simultaneous liver and kidney transplant, a KPS grade C is associated with higher waitlist mortality. 91…”

Section: Karnofsky Performance Statusmentioning

confidence: 99%

Assessing nutrition status, sarcopenia, and frailty in adult transplant recipients

Ruiz‐Margáin,

Macías‐Rodríguez,

Flores‐García

et al. 2023

Nut in Clin Prac

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The assessment of nutrition status, sarcopenia, and frailty holds significant relevance in the context of adult transplantation, as these factors are associated with an unfavorable prognosis; thus, transplant candidates must undergo a full nutrition assessment. Screening tools may be used to prioritize patients, this can be done using the Nutrition Risk Screening 2002 or Royal Free Hospital‐Nutritional Prioritizing Tool. Subsequently, a thorough nutrition‐focused physical examination should be conducted to evaluate clinical signs of nutrition deficiencies, fat and muscle loss, and fluid overload; dietary history and current intake must also be assessed. Apart from physical examination, specific testing for sarcopenia and frailty are recommended. For sarcopenia assessment, specifically for muscle quantification, the gold standard is the cross‐sectional measurement of the muscle at L3 obtained from a computed tomography scan or magnetic resonance imaging; dual‐energy x‐ray absorptiometry is also a good tool especially when appendicular skeletal muscle index is calculated. Other more readily available options include phase angle from bioelectrical impedance or bioimpedance spectroscopy. In the sarcopenia assessment, muscle function evaluation is required, handgrip strength stands as the primary test for this purpose; this test is also part of the subjective global assessment and is included in some frailty scores. Finally, for frailty assessment, the Short Physical Performance Battery is useful for evaluating physical frailty, and for a multidimensional evaluation, the Fried frailty phenotype can be used. Specifically for liver transplant candidates, the use of Liver Frailty Index is recommended.

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Karnofsky performance status predicts outcomes in candidates for simultaneous liver‐kidney transplant

Cited by 12 publications

References 33 publications

Frailty and solid-organ transplant candidates: a scoping review

Frailty and solid-organ transplant candidates: a scoping review

Burden of early hospitalization after simultaneous liver–kidney transplantation: Results from the US Multicenter SLKT Consortium

Assessing nutrition status, sarcopenia, and frailty in adult transplant recipients

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